Ghanaian Chronicle

Neuro-Geriatrics, Health For “The Old”

Date published: December 5, 2012

Around the year 898 AD, the Arab Physician, Kitab Al-Jazaar Al Qarawain, wrote a book, which stands acclaimed as the very first on what could be described as a text-book on Geriatrics, under the Arabic title, “Kitab Tibb al makayik.” Translated, it said, “A Book in medicine and Health of the Elderly.”  He is believed to have been the author of yet another treatise on “Sleep Disorders.”  It was not until almost a thousand years thereafter, in the  year 1881, that the first hospital for ‘Geriatrics’ was opened in Belgrade, Serbia, under the tutelage of  the brilliant Physician, Dr. Laza Lazabrevic. Then came the turn of the New York State, some 25 years later, to possess such a facility.  Given the truism that the Phoenicians in the Nile Basin, just like the Incas in Latin America, successfully carried out craniotomies some 3,000 BC, and yet died on the average (especially the Pharaohs) very young, the most logical conclusion one would draw, should be that we, as ‘homo sapiens’, didn’t take a liking to “old age”, so we cared little to preserve it.  Talking of Senescence/Geriatricum, it seems uneasy where to put a mark. All the same, you wouldn’t be too wrong when you would pick two-score and five, so as to be three decennia away from the Biblical landmark, and say 45 plus, or minus five years. You might also find it  interesting, a small study that was carried out very recently in our environment, whereby over a period of about a year, 60 men (but only half as many women), were questioned, all above the age of the 70 landmark, on what they most did not find so enticing about aging. A staggering 80% of the men detested the “languishing” of sexual performance as their biggest worry, with advancing age. The ladies, most of them, ‘got fed up’, with their spouses, complaining so much of not being able.., as they once were.  They had, as would be expected, other complaints, but the finding in our midst corresponded roughly to what men elsewhere too, so often worried about, when at the same age bracket, and some four decades ago, even in the wake of  post World War II opulence in Germany, for example. The success of a “Ginseng” in Germany in the seventies would obviate such a study presently. At the time the queues in front of the pharmacies had not been seen before, when certain commodities (butter, chocolate and banana), suddenly appeared in the “Kaufhaeuser,” and yet not enough to get around. Everybody wanted the “Wonder-Ginseng”, from Thailand for the glorious ‘spousal-nuptial pacification’.  It stands true that man would go anywhere, no matter how far, and pay any money if it would stop him from aging.  But, since that seems not a reality, and not in the foreseeable future, are there any alternatives? Look at it this way.  Why link Geriatrics with Neurosurgery?  The Central Nervous System (the Brain and the Spinal Cord), and the “appendages”, the Peripheral Nervous System –which is the rest of it, would complete “the electrical network!” It is more essential than Medical Science could appreciate presently. Could we agree, for the sake of simplicity, that hardly a system is as essential, and at the same time, as sensitive as the “nervous system?” Diseases that affect the nervous system examples of which may be cited as “Stroke”, or spinal cord dysfunction, be it traumatic or non-traumatic, has been observed to shorten an individual’s lifespan, hardly comparable to any other affectation. This is mainly as a result of degeneration and dysfunction of the respective organs. For example, the brain and the spinal cord both make 1,700 kg out of the entire average body-weight (2.5 percent, calculated from the 70kg of the average Homo sapien,) out of which the CNS makes so much. The brain alone commandeers 2.5 litres of the minute volume, i.e. the total amount of blood that the heart pumps into circulation in a minute, which is six litres. 25% goes into the cranium.  The brain has a very high demand for Oxygen. Talking of energy requirement, the brain is not as tolerant to oxygen deficiency of Oxygen and Glucose, as other organs (e.g. the liver, and kidney).  The brain is poor in faculties of regeneration, but the issue gets to be more complex, when as observed since over a century, vessels carrying “essential substances” to the brain undergo changes inimical to proper functioning of the brain substance. Arteriosclerosis is such a process which narrows the vessels, and in biologically very unfortunate situations, the vessel may be blocked completely by an object called “thrombosis” or clogging together of debris. Linked with old age are processes that lead to cell-degeneration, through changes that mostly are not reversible. Senescence is the process that may occur within the cell that eventually would lead to the cell getting “stunted”, or going through apopththosis, dying, as though programmed.  The organs that are so directly linked to metabolism, such as the liver, the kidney, and/or with the respiratory system, such as the lungs, may be drawn into some chronic processes or acute situations that may compromise respiration, and with it, adversely affect Oxygen supply to the brain, for example. The two kidneys, out of which we essentially could do with one only, have the function of detoxifying the blood in a way similar to what the liver does, but not quite the same. The pancreas secretes a number of enzymes, the “most critical” of which one would so often hear about, is INSULIN. Should it fail in ‘its mission”, the end-result may be a catastrophe that only might be reversed, if it could be transplanted. The brain of the elderly person has been bombarded with all the possible hazards mentioned above. It may get atrophied, and henc lose function. It could get infarcted, with catastrophic results, including acute death or chronic debilitation.  The peripheral nervous system could get “attacked” by the effect of uncontrolled diabetes mellitus (diabetic polyneuropathy).  Blindness is often the result of uncontrolled/not well controlled blood sugar levels. Diabetic “vasculo-neuropathy” is the forerunner of the feared diabetic foot, which in parts of the world (under-developed nations), often leads to the catastrophe of leg-amputation. Could the brain be transplanted? The late Premier South African Cardiac Surgeon, Prof. Christian Barnard, in a radio-television interview in 1971, said it in Rome: “When we transplant the Brain, the donor becomes the recipient, and the recipient the donor.” The “confusing” answer coming from the genius did only underlie the problems that would be confronting the would-be team and all concerned with such a conceptual transplantation. Medical science would keep on transplanting all organs else, for yet a while.  Kofi Dankyi Beeko, MD E-mail: [email protected]

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